Psychology Class Notes > Psychology Disorders (Abnormal Psychology)

Abnormal Psychology - Let's start with a question. NORMAL - what does it mean to you? This word seems to mean very different things to different people and especially, in different situations.

How many of us here would say we are normal? What if asked to evaluate your own intelligence - would you say your intelligence level or ability is "normal"?

Is normal average. Certainly the word average constitutes the majority, and isn't it the majority that determines what is normal? Is normality simply fitting within the confines of the majority - in other words, being average?

I. Basic Issues

A. What is "abnormal" behavior?

1. Contributes to maladaptiveness in an individual
2. Considered deviant by a culture (thus it is culture specific)
3. Leads to personal psychological distress
4. unusual, rare, but not necessarily bizarre

B. What are some common myths about abnormality?

1. Bizarre
2. Different in kind
3. dangerous
4. Shameful
5. Self-induced

C. Let's take a closer Look at each component

1. Maladaptive Behavior

a) an inability to handle daily life events For example, many people drink, but when drinking interferes with social and/or professional life it can be considered maladaptive.

b) this is a very important component in diagnosing problems such as drug abuse

2. Deviant Behavior

a) behavior that falls outside the boundaries deemed acceptable by a culture

For example: *men wear kilts in Scotland, *living arrangements in villages in Papua New Guinea

3. Personal Psychological Distress

• not necessarily overt behavior...reports of feelings of sadness, anxiety, etc., to friends and/or family.
• important in determining and diagnosing psychological disorders

4. Unusual but not necessarily bizarre like deviant behavior, this is often governed by the culture. But, now we also include personal history, experiences, race, religion, etc. D. Behavior on a Continuum Many textbooks do good jobs of explaining how behavior can be viewed on a continuum from normal to abnormal as opposed to ONLY normal or abnormal. WHY this is important:

1. It is difficult to accurately distinguish normal from abnormal
   On occasion don't we all have some personal distress?
   

2. We have ALL displayed some abnormal behavior at some point in our lives

**the key is how much of each and how often do they occur.

E. What causes abnormality? Models of Abnormality.

1. Medical model: mental illness/also referred to as Biological Model

• illness idea (abnormal behavior, maladaptive behavior, mental disorder, psychopathology, emotional disturbance, behavior disorder, mental illness, mental disease, insanity)
• organic, yes: alcoholics, senility, strokes,
• functional, ?: no link to physical factors

2. Psychoanalytic - all disorders due to internal problems/turmoil. He related ALL neuroses (abnormal behavior caused by anxiety) to the Oedipul Complex.

3. Learning Model stems from Bandura's social learning theory - behavior is the result of observation and imitation of others.

4. Cognitive Model

thought processes cause distress - follows the Psychosomatic Model

5. Legal Model

if you break the rules or laws determined by society you may be considered psychologically imbalanced. In fact, many say that the legal definition of "insanity" is being incapable of standing trial.

II. How do psychologists identify disorders? The classification problem: disorders (problems not clear cut)

1. DSM-IV of APA (uses a MULTIAXIAL system) *Axis = dimension

2. Axes I & II - used for diagnosis of disorders

• Axis I - identification of major disorders
  
• Axis II - identification of personality or developmental disorders (often comorbidity exists)

3. Remaining Axes are then used for supplemental information

• Axis III - physical problems
  
• Axis IV - severity of stress
  
• Axis V - current level of adaptive functioning The multiaxial system is a good thing - it attempts to show the BIG PICTURE of the person and not just focus on one "abnormal" or "unusual" factor, symptom, behavior, etc.

III. DISORDERS

A. Anxiety Disorders: All characterized by high (very high) apprehension and anxiety, tension, and nervousness

1. Generalized anxiety disorder and panic consists of prolonged, vague, unexplained but intense fears that do not seem to be attached to any particular object.

• very much like regular fears, but no actual danger
  
• objective anxiety vs. free-floating anxiety
  
• tense, apprehensive (concerns about future), difficulty concentrating, irritable, worried, can't concentrate
  
• headaches, insomnia, upset stomach, aching muscles, need to much sleep, sweating, dizziness, etc.
  
• Hypervigilance - always scanning the area for danger although none usually exists.
  
• GAD - anxiety persists for at least 1 month (usually longer) and is not attributable to recent life experiences (although they may play a role)

2. Panic disorder

• severe anxiety moments
• "nervous breakdown," a case of the nerves

3. Phobias: an intense, recurrent, unreasonable fear of a specific object or situation which leads to avoidance of the object or situation

• Simple Phobias (relatively rare) - an isolated fear of a single object or situation that results in avoidance
  • miscellaneous category comprising irrational fears that don't fall under any other category. For example - claustrophobia
    
• Social Phobias - characterized by fear and embarrassment in dealings with others. Often the fear is that their anxiety will be seen by others.
  • Examples: public speaking, eating in public, interpersonal relationship fears (asserting one's self, criticism, making a mistake, etc).

4. obsessive-compulsive

• obsessions: persistent, irrational thought that presses itself into awareness at odd times, idea that keeps returning

* often involve doubt, hesitation, fear of contamination, or fear of one's own aggressions

• compulsion: action that is continually repeated, e.g., mother with obsession seeing herself stabbing kids, leads to counting up knives, keeping them locked
  
• most common compulsive behaviors: counting, ordering, checking, touching, and washing
  
• some are purely mental rituals like reciting a series of magical numbers to ward off obsessive thoughts

* Most Common Features:

• obsession or compulsion keeps getting into awareness
  
• feelings of anxiety or dread occurs if the act/thought is thwarted
  
• seen as a separate being, not part of one's self, and is uncontrollable
  
• person realizes how irrational their behavior is but can't stop
  
• person feels the need to resist

* variety of rituals is endless, but there are 4 main types of preoccupations:

• checking - doors, stoves, etc.
  
• cleaning - refuse to use public phones, restrooms, etc., vacuum all day long
  
• slowness - can't get through other tasks - preoccupied with compulsion
  
• doubting OR conscientiousness - even when something is done carefully they feel it was inadequate.

* Twin studies have indicated some support for the genetic basis

B. Somatoform disorders

1. Hypocondriasis: incessant worrying over health (not actual, physical illness as in stress-induced illness like ulcers)

2. Conversion (loss of sensory functions): not psychosomatic illness, real loss e.g., glove anesthesia, "hysterical blindness"

C. Dissociative: several varieties, all ways to keep information about self out, lock things away, loss of identity

1. Amnesia: forgetting past

2. fugue states: flight away from life, self: sometimes short, sometimes long

3. multiple personality not same as a split personality, three faces of Eve

D. Affective/Mood Disorders

definition - disturbances in mood or emotionality not due to any physical or mental disorder (no bereavement, anxiety disorder, etc).

There are essentially 2 types: Depressive disorder, and Bipolar disorder

1. Depressive Disorder (unipolar)- persistent feelings of sadness and despair, and a loss of interest in previously enjoyable activities/events. Also may include: marked weight loss, sleep problems, unclear thinking, etc.

*a depressive episode must last for at least 2 weeks for classification. Then, if there are 2 episodes of at least 2 week episodes, the person is diagnosed with Major Depression:

a) Major Depression

1) Extreme unhappiness, may be attributed to some specific
factor, but prolonged

2) some changes from normal to depressed

Normal	Depressed
friends	antisocial
affection	revulsion & loss of feelings
favorite activity gives pleasure	boredom
humor/amusement	loss of humor
self-care	self-neglect
success/achievement	withdrawal
self-preservation	suicidal thoughts
good sleep	disturbed sleep
energy	fatigued

If the depressive episode lasts for an extended period, person may be
classified as having:

b) Dysthymia: affect is not so negative, but very long-term

* like depression, except continous, chronic state that has lasted for as much as two years (one year
for adolescents)--almost like a "depressive personality disorder", with depression being a
fundamental part of the individual's personality

2. Bipolar Disorder (Manic-depressive)

a) shifts back and forth in emotion, from depression (as described above to mania: extremely high amounts of energy, excited

b) nature of the manic phase

• distinct period in which the predominant mood is quite elevated, it may look euphoric and cheerful to an uninvolved observer, but to those who know the person well it is clearly excessive
  
• mania is usually accompanied by a decreased need for sleep, person has lots of energy
  
• you see a dramatic impairment in the person's functioning - they are bouncing off the walls,
  agitated
  
• it's the opposite of depression in that you see the manic excessively involved in pleasurable
  activities, shopping sprees, hypersexuality
  
• their speech may be loud, rapid, difficult to interrupt, and full of jokes and puns

c) Symptoms

• depressed and pessimistic to uninhibited, delusions of grandeur, wild ideas
• slow, tired, no energy to enthusiasm, excitement, energetic
• speech slow to mile a minute talking, joking
• sleeps a lot to little sleep
• euphoric, happy to sadness
• thinking is blocked, no ideas to wild
• thoughts, ideas, bizarre behavior

E. Schizophrenia - actually part of a category of mental disorders known as psychoses

psychosis - a disorder that involves alterations of perceptions, thought, or consciousness. A psychotic person is said to be detached from reality (not necessarily continuously) but believes their perceptions to be true.

• most serious, 1 in 50 in U.S. (1% of poulation), 25% of hospitalized mentally ill, high return rate,
  usually under 35 when first admitted
  
• characterized by psychotic symptoms, which means a loss of contact with reality
  
• the individual detaches from reality and develops an elaborate inner world which is illogical and
  fantastic
  
• also characterized by thought disorder, which involves a kind of unraveling of thinking processes, the person's associations become loose, and language and communication become disturbed, what they say makes no sense (WORD SALAD)
  
• why called split personality: split from reality, doesn't react right; also, the self is split into fragments (but this is NOT the same as multiple personality)

Symptoms: best considered to be a group of psychotic reactions

• Deterioration of behavior - the person declines from a previous level of functioning, "not himself" e.g., example of Fred who went from being an honor student in school, to failing grades, getting into trouble, and using drugs over a two year period until finally having psychotic breakdown at age 16
  
• Irrational, disordered thought(delusions), incoherence in ideas Delusions are beliefs or a belief system that a person has which are almost certainly not true; thoughts being broadcast from one's head often these have religious content or the conviction that one is being controlled by outside forces, e.g.,

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